Anatomical and pathological considerations in percutaneous vertebroplasty and kyphoplasty: A reappraisal of the vertebral venous system

被引:167
作者
Groen, RJM
du Toit, DF
Phillips, FM
Hoogland, PVJM
Kuizenga, K
Coppes, MH
Muller, CJF
Grobbelaar, M
Mattyssen, J
机构
[1] Univ Groningen Hosp, Dept Neurosurg, NL-9700 RB Groningen, Netherlands
[2] Univ Groningen Hosp, Dept Anesthesiol, NL-9700 RB Groningen, Netherlands
[3] Univ Stellenbosch, Dept Anat & Histol, ZA-7600 Stellenbosch, South Africa
[4] Univ Chicago, Spine Ctr, Chicago, IL 60637 USA
[5] Free Univ Amsterdam, Med Ctr, Dept Anat, Amsterdam, Netherlands
关键词
vertebroplasty; kyphoplasty; bone cement; embolism; complications; vertebral venous system;
D O I
10.1097/01.BRS.0000128758.64381.75
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objectives. To focus attention of the clinician on the anatomy and (patho) physiology of the vertebral venous system, so as to offer a tool to better understand and anticipate ( potential) complications that are related to the application of percutaneous vertebroplasty and kyphoplasty. Background. Percutaneous vertebroplasty and kyphoplasty are newly developed, minimally invasive techniques for the relief of pain and for the strengthening of bone in vertebral body lesions. With the clinical implementation of these techniques, a number of serious neurologic and cardiopulmonary complications have been reported in the international medical literature. Most complications appear to be related to the extrusion of bone cement into the vertebral venous system. Methods. The literature about complications of percutaneous vertebroplasty and kyphoplasty is reviewed, and the anatomic and ( patho) physiologic characteristics of the vertebral venous system are reported. Based on what is currently known from the anatomy and physiology of the vertebral venous system, the procedures of percutaneous vertebroplasty and kyphoplasty are analyzed, and suggestions are made to improve the safety of these techniques. Conclusions. Thorough knowledge of the anatomic and ( patho) physiologic characteristics of the vertebral venous system is mandatory for all physicians that participate in percutaneous vertebroplasty and kyphoplasty. To reduce the risk of cement extrusion into the vertebral venous system during injection, vertebral venous pressure should be increased during surgery. This can be achieved by operating the patient in the prone position and by raising intrathoracic venous pressure with the aid of the anesthesiologist during intravertebral instrumentation and cement injection. Intensive theoretical and practical training, critical patient selection, and careful monitoring of the procedures, also taking into account patient positioning and intrathoracic and intra-abdominal pressures, will help to facilitate low morbidity outcomes in these very promising minimally invasive techniques.
引用
收藏
页码:1465 / 1471
页数:7
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